2015 ISAKOS Biennial Congress Paper #166

Pre-Operative Anaemia and Length of Stay in Primary Arthroplasty Patients

Amarvir Bilkhu, MB/BChir, MA, MRCS, Leeds UNITED KINGDOM
Osman Riaz, MBChB, MRCS, Huddersfield, West Yorkshire UNITED KINGDOM
Gurudatt Sisodia, MBChB, BSc, MRCS, Greater Manchester UNITED KINGDOM
Gautam Chakrabarty, MBBS, D Orth, MS Orth, MCh Orth, FRCS Ed, FRCS, Huddersfield UNITED KINGDOM
Huddersfield Royal Infirmary, Huddersfield, Yorkshire, UNITED KINGDOM

FDA Status Not Applicable

Summary: Undetected pre-operative anaemia in elective primary arthroplasty patients increases the length of inpatient stay.

Abstract:

Background

Untreated pre-operative anaemia can be associated with an increased peri-operative morbidity and mortality after orthopaedic surgery, as well as an increased likelihood in the need for peri-operative blood transfusion.

AIMS
To determine the prevalence of pre-operative anaemia amongst patients undergoing elective primary arthroplasty within our trust and to assess the impact upon the length of stay.

STANDARDS
The Network for Advancement of Transfusion Alternatives (NATA) recommend as part of their guidelines that undiagnosed anaemia should be detected in pre-operative elective surgical patients by a Hb level within 28 days of the surgical procedure, and that the patient’s target Hb should thus be normalised in accordance with WHO Criteria (Males >13g/dL-1 and Females >12g/dL-1).

Methods

195 consecutive patients underwent elective primary hip and knee arthroplasties in Calderdale & Huddersfield NHS Trust from January to March 2014. These were retrospectively reviewed in order to ascertain their pre-operative Hb and the timing of this test before surgery. The length of stay between anaemic and non-anaemic was compared as a secondary outcome and analysed using an independent t-test.

Results

195 patients were included. The mean age was 69.4 years. 134 (68.7%) of these were total knee replacements and 61 (31.3%) were total hip arthroplasties. The male to female ratio was 84:111. 188 patients (96%) had their Hb checked within 28 days of surgery, 78 (40%) of these patients were biochemically anaemic: 31 males (36.9%) and 47 females (42.3%). The mean length of stay was significantly lower for non-anaemic patients compared to anaemic patients at 3.8 (±2.8) days and 5.3 (±2.8) days respectively (p<0.05)

Conclusion

The vast majority (96%) of patients in our trust had their Hb checked within 28 days of elective arthroplasty surgery. However, 40% of patients went on to have their surgery despite a biochemical anaemia. This was associated with a significantly greater mean length of stay. Thus, increased compliance with NATA guidelines needs to be enforced for the benefit of reducing inpatient hospital stay.